Why the iPad will not be used for Health Care IT
With the much-hyped release of the iPad, Apple has their sights set on the Amazon Kindle’s market share; and I’m sure they will do well. However, some health care IT industry heavyweights have gone so far as to suggest that the iPad will be greatly utilized in the health care setting and revolutionize the way we do business.
While I do think the iPad is incredibly shiny and is great computer replacement for your grandma, I think it’s a bit of an exaggeration to suggest that it will ever be fully adopted by Healthcare IT shops. Here’s why:
1. It’s a Tablet.
We have this on-going love affair with the idea of the tablet based computer. We can imagine the freedom to roam about, simplified interaction, minimal commitment, and the pride of knowing that we have something no one else has. In practice, however, tablet computers have always been an awkward lot. Too big to put in your pocket, too small to see enough data on the screen, too heavy to carry around for very long, and too expensive to set down any where. I don’t want to even think about how much MRSA/ORSA could be cultured from the screens.
2. Windows OS.
Most Healthcare IT shops are PC based (or for you old schoolers – IBM compatible). The infrastructure to support a PC is already in place. Yes, there are MacBooks and iPhones scattered throughout the hospital staff, but 99% of the devices deployed in the facility are running a Windows-based OS. Not that Apple’s OS X isn’t a capable operating system, it absolutely is. Unfortunately, the iPad doesn’t harness the full* power of OS X; it actually runs a modified and backwards compatible version of the iPhone OS (a derivative of OS X stemming from Apple’s Darwin code*).
*corrections
3. iTunes.
I won’t tread too far into my personal loathing of this application. Let’s just say, it would be incredibly complex to support the software needs of an array of iPads related to their vampiric tethering to this application. Apple does provide business grade solutions for software deployment, but at some point, someone will plug this baby into their home computer to sync their music, and your hospital help desk will immediately place a large bounty on the head of the manager that approved this venture. Also, there are very few no CCHIT certified health care software products that offer interfaced iPhone/iPod Touch apps. And no Epic, Haiku doesn’t count yet.
4. Price.
For the 16GB, 32GB and 64GB Wi-Fi only models, you will shell out $499, $599, and $699. Or add $130 for Wi-Fi-plus-3G models and you’re looking at $629, $729, and $829; plus the $30/month 3G service fee from AT&T. Basically, you could buy 2-3 fairly capable PC-based netbooks for the price of 1 iPad.
5. Multitasking.
PCs have it. The iPad does not (at least until OS4).
6. Expansion ports.
There are no included USB ports of any sort. Instead, you have to purchase a $29 Camera Connection Kit that includes two dongles: one for USB and one for SD cards. The 30-pin docking connector used to sync and charge doesn’t officially count.
7. WiFi + AT&T 3G = still not connected.
Most hospitals have a pretty solid WiFi network. It’s too bad your IT security guys are reluctant to authenticate your device allowing you to connect to it. Considering AT&T’s nose-thumbing at actually improving their coverage, it is also likely that you won’t be able to connect to the web via your cellular connection within the walls of your facility anyway.
8. Safari web browser.
The web browser built into the iPad / iPhone OS is based on the Safari rendering engine. Many applications do not properly support the Safari browser as most healthcare software vendors still use Internet Explorer as the gold standard.
*Update – As of April 14th, you can download the Opera Mini web browser from the Apple App Store. Unfortunately, actually using Opera Mini to view medical records could be a teensy weensy HIPAA violation.
9. HP Slate – the idea (but really the bulletproof Lenovo version).
This little gem from Hewlett Packard could quite possibly be the game changer for tablet PC use in the healthcare setting. Windows OS (XP, Vista, or Win7), check. Deploy-able with current infrastructure, check. Price below <$600. Multitasking, check. USB expansion ports, check. WiFi, check. Hundreds of gigabytes of hard drive storage that I can directly access, check. Internet Explorer, yawn…but check. Touch screen, check.
10. Other silly bemoanings.
No wireless synchronization. No Adobe Flash support in the web browser, 4:3 screen aspect ratio, relative lack of storage space, kludgy copy and paste, projected 10 hour battery life (which really means 6-8 hours of use), and no on-board camera.
Is Lenovo down in the lab making a battle-ready version? Dear Lord, we hope so.
[...] The Apple iPad has been described as “impossibly fast” with Apple’s own A4 processor. BBC has high expectations of the new device, as has The Guardian. And from a medical perspective, opinions are mixed. John Halamka, CIO of Harvard Medical School, is in doubt about the success in healthcare, doc2doc is more negative. The same can be said for Healthcare IT Squad. [...]
I do not completely agree. Yes, as usual the price of Apple products is higher than for a PC related counterpart. And yes, you also pay for the looks. But I don't need all the options a PC gives me, I don't need boot times, I don't need heavy weight, and I dare to doubt battery lives of such PC tablet devices: would they really last longer before recharge?
For me, there would be one major reason to buy the iPad: as an e-reader for scientific literature. In color. And with the Papers-software for iPhone from mekentosj.com
If that would run smoothly, it's worth the money for me. I don't need 3G, but rich media articles would do well this way.
All the rest is a bonus…
I blogged about this, and linked your article, at:
http://blog.digitalneurosurgeon.com/?p=646
Best regards,
Pieter Kubben, MD
Dept of Neurosurgery
Maastricht University Medical Center
The Netherlands
Hey Jared
Too much Microsoft cool-aid?
Nah…I'm a big fan of Apple. The iPod absolutely changed the world of personal music devices. The iPhone (and I own one) is pretty revolutionary in it's own right. It is the best pocket-sized computer with phone-like capabilities on the market. Macs & OS X are pretty freaking sweet. Apple's focus on UI almost makes thoses devices worth the price.
What I don't dig, however, is when people hype a device as the next big thing without knowing anything about the industry – or the specifications of the actual device!
I think Apple missed out on creating an utterly game-changing device. By tucking in a few more essential items (mainly usb, storage, and OS X) they could have decimated the ereader, netbook, and tablet market.
Thanks for the gut-check Doc
I was a little disappointed to see that the iPad was basically a large-screened iPod Touch. Nonetheless, there are already some radiologic apps in the works, and the thing might fly higher than we expect. Don't discount Apple's marketing prowess, either.
The problem with using Mac OS X on the iPad is this, Mac OS X is using a desktop metaphor which is incompatible with what Apple is trying to do in regards to mobile multi touch computing. That is the reason why they created the iPhone OS based on Mac OS X to meet the unique demands of touch screen computing. In time, the iPhone OS would be evolve and grow like it's older sibling and I will not be surprise that in the future, it will be equal to it's big brother in terms of functionality, reliability and stability.
In regards to storage, well, solid state drives that are greater than 64 GB currently exist in small quantities that would make them incredible expensive in the short term. But with the arrival of the iPad, iPod Touch , iPhone and other multitouch devices, by next year and the years after that, companies who make these solid state drives will be motivated to make new drives that have greater storage, more reliable and in greater quantities with the added benefit that will be much cheaper to produce which would translate to savings for us end users in the end.
Until the iPad gets into the hands of health professionals like us, it's capabilities and shortcomings are just that. Well informed guesses and assumptions .
Jared I disagree with you. Many applications used in health care settings are or could be deployed as web-based applications. This is true of almost all patient flow and bed management systems, and is true also of some documentation systems. I can virtually guarantee you the iPad *will* find its way into hospitals, but likely not as personal machines. Rather, we'll see these deployed as a part of a solution package, and they will be supported by the hospital IT and by the vendor, and likely they will not leave hospital premises.
Regarding the tablet issue: these devices cost dramatically less than competing devices, and have higher resolutions. They also have longer battery lives. All of these factors have worked to limit the adoption of tablets in health-care settings. The iPad significantly erodes many of the barriers to entry that previously existed.
FYI, I develop health-care applications for a living. In my view, the entry level iPad is a fantastic device platform for deploying web-based applications, and I believe we will see this within the next 1 to 2 years.
Dumb article. The iPad is not even out and pundits are already claiming it is a failure, as predicted by NY Times columnist David Pogue.
Couple of comments:
1. It is NOT a tablet in the sense of the Windows laptops. MRSA/ORSA can get on any device so tthat is not a specific issue with the iPad. Plus, antibacterial cases are in the works: http://www.proporta.com/F02/PPF02P05.php?t_id=4...
http://www.ninjacase.com/collections/ionarmour-...
2. Windows OS: This comment is irrelevant. More and more apps now are web-based and active-X is being relegated to the scrap heap. Even Windows users are dumping Internet Explorer for Firefox and Google Chrome. Webkit is becoming the new standard and is completely supported by the iPad.
3. iTunes: really has nothing to do with running an App on the iPad.
4. Price: Most of the netbook companies are scrambling due to the low price of the iPad. Three netbooks for $500 – sounds like quality equipment!
5. Multitasking: not relevant for a health-related App. In fact, probably more stable to NOT multi-task.
6. This is a non-issue.
7. WiFi works great in my hospital with my iPhone, so why wouldn't the iPad. Yet another dumb comment. Even the haloed netbook would require WiFi.
8. Addressed above. Safari is based on Web standards. Internet Explorer is becoming more web compliant (IE 6 is basically dead). If vendors write to W3 standards, this will not be an issue. Plus, most smartphones now support webkit, which is the new 'standard'.
9. HP Slate – who knows, also not out yet. Your comments show your bias.
10. Flash is going to be a dead proprietary program. The web is going to HTML 5. Non of the big companies (Microsoft, Apple, Google) are pushing Flash.
I completely agree with you on the e-reader side of things. I'm sure the iPad will do really well in that market. The Kindle mimics book reading as much as a device can and is incredibly easy on the eyes, but is overpriced and underwhelming. The iPad, at least, gives you multimedia, email, and web browsing – which are worth the price of admission to many who don't need (or can't handle) the full functionality of a laptop/desktop. I just think the tech-savvy crowd (myself included) expected it to improve on the iPhone strengths and be a small workhouse, not a bigger version with the same weaknesses.
I did not mean OS X in it's current iteration – more like OS X background with new (borrowing from the iPhone OS) iPad UI.
And really I could deal with <100gb of storage if Apple would actually allow basic file management without having to jailbreak the device. Just being able to manually upload/save/transfer/delete files to and fro would make a HUGE difference in functionality.
Forgiving my ignorance…why couldn't Apple include the drives that are in the 160gb iPods?
Touche Robert!
1. You are absolutely right. It is not a tablet in the sense of windows laptops, but physically, they are the most similar and are held/carried/proposed to be used in the same fashion.
And yes, MRSA/ORSA is everywhere, especially mice/keyboards.
2. It's not about web users moving away from IE. It's about healthcare vendors not broadly supporting and IT shops not installing firefox, chrome, or safari for employee consumption.
3. Minus the business deployment tools Apple provides, iTunes has everything to do with running an app on the iPad.
4. $829 + $130/yr = $959 = 96.8% for three of these.
5. Multi-tasking is absolutely imperative. Users are often running multiple applications (that are not integrated) to handle the needs of their charting – an EMR, MAR, PACS, CPOE, Labs, etc. etc. Then drop email and general web browsing on top of that.
6. USB ports could come into play if you ever want to attach a camera, a tethered barcode scanner, mouse/keyboard combo or external monitor/projector. Yes, some of this could be addressed with bluetooth (if the devices you own have that functionality).
7. It's not about Wifi actually working, it's about whether or not your IT guys will permit you to authenticate your iPad onto the internal network to be able to access the hospital's web-based applications. You are basically out of luck, unless they've loaded Citrix XenApp.
8. IF vendors write to W3 standards…IF, then you are correct. It should be less of an issue.
9. Sorry to be anti-Apple, I honestly wanted the iPad to blow everything else out of the water (so I'd have a reason to buy one), and it didn't.
10. Flash is dead, long live Flash. But it's still out there en mass. And it's frustrating as all get out to not be able to load some big chunk of a website because Apple and Adobe are having a pissing match. Point taken – HTML 5 is on the horizon, but again…all the browsers and software vendors have to get on board for full implementation.
2. IT will have to change, maybe kicking and screaming, but the writing is on the wall. Not only iPad but also iPhone, Android, Palm PRE and others are web-kit and will eventually be supported (whether IT likes it or not!)
4. For in-hospital use, the $499 device will be fine. No need for 3G. For out-of-hospital, one could tether the device to their cell phone (or hook into WiFi which is becoming more and more ubiquitous) or just pay for 3G if needed. PS: The 16 GB device (more than enough space for hospital/physician use on the 'cloud') with 3G is $629.
http://www.apple.com/ipad/pricing/
5. Disagree. Most functionality will be thru the Web browser. Dedicated Apps can also have Web access if needbe, reducing the need and complexity of multitasking – check out Tweetie 2 among others as an example of this.)
7. I can access WiFi with my iPhone at the two hospitals where I practice. This is really a non issue (and certainly not an iPad issue).
8. See web-kit comment above. Vendors are already dumping IE6 support, which is the real reason browser support is an issue.
10. Flash will not be required for medical/EMR/HIS applications, so again not an issue. Personally, I'm glad there is no Flash on the iPhone/iPad (it is a buggy resource hog!)
2. I concur, but I'm talking about the current state of affairs (and the near future). CCHIT certification (secondary to the ARRA stimulus here in the US) has taken the focus for many emr vendors. Writing compliant code usually takes a back-burner to meeting core functionality requirements.
4. Please show me a non-jailbroken cellphone tethering app…and tack AT&Ts 5GB/mo limited tethering fee onto your prices.
5. I'm not disagreeing. I'm just talking about the current state of silo-ed legacy software that still exists in many facilities.
7. Again…not the ability to get on wifi, but the ability use the supported encryption and authentication methods your facility uses to get on the secured intranet.
8. See #2 above.
10. True, it is not required, but it does exist.
Because they are hard drives similar to what you see in laptops and external storage and it's disadvantages are that they have moving parts which can cause failure , higher power requirements and two more crucial facts, the weight and the size of the hard drive which affects the form factor of the iPad. The iPad from the look of things is much thinner than the iPod Classic and the current thinking of Apple is this , thinner and lighter is much better than being thick and heavy even though the difference might be in ounces.
Solution for Windows Fans:
http://www.pcworld.com/businesscenter/article/1...
“Want to run Windows 7 on the new Apple iPad? Citrix says it will soon be possible–at least virtually–using a new version of its Citrix Receiver software.
Promised to be ready when the tablet computer ships in March, Citrix says the new software, based on the current iPhone version, is a response to questions about how the iPad might find a home in the enterprise.”
Jared I think you might be generalizing from your personal experiences to the market as a whole.
First, CCHIT currently only certifies EHR systems, but there are many classes of application used in the hospital enterprise that could be very usefully deployed on a device like the iPad. Bed management, asset tracking, automated workflow support – all of these classes of applications are rapidly expanding in the enterprise and they don't need CCHIT certification. You may be correct that EHR vendors will be more interested in CCHIT in the near term, but focussing on EHR systems is a bit myopic in my opinion.
Second, just because your IT department deploys Citrix and is loathe to allow your personal device on its network doesn't mean either factor will apply in a wide-spread sense in the industry. As I mentioned before, these devices are likely to find their place in the portfolio of solutions that get selected in the C suite, and if the C suite selects them, what IT has to say means absolutely zero. Moreover, most WiFi networks are using WPA or some such in healthcare facilities, and of course these wireless encryption standards are supported by iPad.
Third, regarding 3G – I fail to see why this matters at all. Within the enterprise, 3G connectivity is not going to be the conduit for data exchange. There are obvious reasons for this, so the fact that the 3G version of the device only runs on AT&T, and is more costly, is really a moot point. Having a cellular receiver / transmitter in these devices, for the purposes of a health care institution, is absolutely pointless.
In general, I think you have adopted the stance that unless this thing can run legacy apps, it won't get adopted in healthcare settings. I think that's a weak assumption. Clinicians don't expect to be able to run every application on every client station they interact with; somebody running through a physical exam template doesn't expect to have full fledged PACS access through the same device. They may want to see an image, but that is a task that can be handled through a web browser. My general point is this: solutions which utilize the strengths of these devices to add value to the enterprise will get adopted; it isn't a matter of if, it is merely a matter of time-frame. As i've said, I think we will see significant movement in this space within two years, and that is not very long at all in terms of system development and marketing.
Power requirements. Plus, why do you need to store anything to the device in a healthcare setting? What are you going to store? I design EHR and other healthcare systems for a living, and one of the things facilities are adamant about is that applications do not store data to the local machine; doing so is a tremendous security issue, and is a patient safety issue as well.
This guy is a moron who unconsciously fears that the iPad WILL be used in healthcare in large numbers… possibly threatening his position in some way.
He was wrong on every point, but I don't have the time to correct him… The iPhone is used in many hospitals already, here is just one example…
http://www.apple.com/iphone/business/profiles/m...
The iPad is cheap, very secure, extremely durable, light weight and the size is perfect.
This author is scared, so is spreading misinformation, that's all.
http://www.apple.com/ipad/
the iPad allows file sharing with network servers, so it essentially has infinite storage.
as for disk drives, there is no room, and they eat batteries, but even 16GB of ssd is plenty for most hospital based… tasks so it's not an issue.
Thanks for the vote of confidence – macdrew! Can we keep things above the belt here?
First off – I don't fear the iPad; I welcome it. Mass implementation of the iPad would in no way effect my job position (and would be a great excuse to buy one). I'm all for techno tools or gadgets that help the provision of care. Like I mentioned earlier, I have a first generation (after the price drop) iPhone. I think it's the best personal computer with phone capabilities on the market. I will be buying the new on in June.
However, I don't appreciate marketing hype and fanboy-ism trying to push a device as some sort of industry salvation without knowing what the challenges and undercurrent of the industry are.
All great points tt92618! I am mainly talking about clinical documentation systems.
Recently, portable devices have been the main point of information security failure, with private patient information literally walking off – BCBS and Texas Medical Center. Any new popular device (laptops included) is at great risk for theft. I don't imagine that a facility would implement iPads for bed control or asset tracking when a standard desktop will suffice and will remain an asset.
You are absolutely right on 3G. It is a non-issue if you're on wifi. I mentioned it because I have zero service within my facility (subconscious AT&T rant!) and there has been talk about using the iPad in the field, like home health visits and in developing countries. Also, the AT&T service fee for their data plan would be a substantial budgetary concern – especially if you are mass deploying the iPad.
The iPad will never run legacy apps and I don't have that expectation. Like Robert said above, everything is moving toward a web-based front end. However, I still feel that multi-tasking cannot be simply dismissed.
My biggest point is that in the websphere right now, there is a large disconnect between what we all HOPE the iPad will do and what it technically CAN do. Add in the down economy, tightening of budgetary purse strings, and the apprehension of what healthcare reform could mean; and I can't invision this being corporately adopted on a large scale. Will there be various smatterings and cutting edge iPad implementations? Of course there will, as with any new device.
Storage requirements would obviously vary by role and the device's intended use.
A device for bedside patient care would be fine with limited storage. But even bedside clinicians shuttle around large files (email attachments, word documents, PDFs, screenshots, spreadsheets) and quite often make power point presentations. USB keys abound.
You guys are right though – appropriately locked down network storage mitigates most of this.
Robert – your arguments ar mostly based on “if”, “will”, “could”… Please come back to Earth and be more realistic.
Wow, I am glad I am posting to this one late because, I might have gotten heated up and as I read the whole string, I find points on different sides I like and dislike.
I have been working in Healthcare IT for the last 16 years and the last 6 in Ambulatory Electronic records. I am excited about what the ipad brings to the table and my thoughts on day one were how would it affect Healthcare IT. I can't wait to put one through the tests. I am a very picky gadget guy. Unfortunately, that means I almost never find the perfect gadget in my opinion but ended up choosing between compromises.
Does the ipad look like it solves all of them? Certainly not. Personally I live in an area where AT&T 3G is not an option for me at home.
I think multi-touch could do wonders for the complaints I hear every day about EMR and PACS. “Too much scrolling and clicking,” “not large enough.” I encounter tablets ($1200+ variety) across the country on a weekly basis that are only being used as laptops because the applications have not embraced tablet functionalities. Perhaps a player like Apple is big enough to make application vendors pay attention. I am sure there are vendors who would line up to partner with them. Let's face it Apple has done some amazing things with gadgets that always seem to have some weaknesses (AT&T network, video capture for the iphone, there were bigger, better simpler mp3 players for years before ipod caught the world's attention)
It used to drive me nuts because the rules of logic don't seem to apply to apple. I think it is premature to say it will turn everything upside down. EMR adoption needs a device to make it intuitive, I think it is a step in the right direction. I think I could do a lot with web based applications with the base model with wi-fi, it's certainly cheaper than the convertible tablet PCs I typically see deployed at well over $1000. I'd like to see the ipad with a camera. I don't see a need for 160GB hard drive. I don't see any typing being done on it for anyone looking to be efficient. Send me one and I'll review it!
The funny thing is we don't all drive the same car, so why do we think we'll all are going to like the same device. I've got the motorola droid for a smartphone and love it except for a few things, which usually means my choice will curse it and it will fail miserably.
Has anyone noticed that EPIC, manufacturer of one of the largest enterprise electronic health records (used by Kaiser, Stanford, UC Davis, UC Irvine, UC San Diego, Universities of Texas, Pittsburgh, Oregon and so on) released an iPhone app called 'Haiku' for accessing their EMR from the iPhone? I think it is not a coincidence that the app was released a day or two before the iPad announcement – you can be sure that the developers will have it ready for the iPad on its release. Haiku requires the Summer 2009 release of EPIC (my institution is currently on the Fall 2008 release) for compatibility, but it seems clear that EPIC recognizes the utility of using the iPad and iPhone as thin clients to access their EMR. Topcon (a manufacturer of imaging equipment for ophthalmology) has an iPhone/iPad thin client for their PACS system in beta that they demonstrated at the American Academy of Ophthalmology in San Francisco in October – it was stunning. Clinicians won't use an iPad for heavy typing but the form factor of the iPad will be ideal for rounding and for showing patients x-rays, images, etc.
Some of this makes the blog author's objections (no windows, Safari browser, 3G) irrelevant. Using this in my hospital where there is ubiquitous WiFi to access the EMR anywhere I want without tracking down a COW (computer on wheels) will be terrific.
I mentioned Haiku in #3 and that it is not currently CCHIT certified…yet. Some of Epic's other EMR products are, so I imagine the discussion of certifying Haiku is taking place. You are exactly right inferring that Epic has positioned themselves very wisely in the mobile integration market. Maybe other vendors will follow suit and stop building after-the-fact “mobile” versions to be able to have a bullet point on a sales presentation.
@ JB – would you be interested in doing a demo/webex if you guys get the EPIC Summer 2009 release and Haiku? I would love to see it real world (testing data, of course) without the sales pitch. We could even screencast it and post it here if you'd like. Let me know on our Contact Page.
[...] The day is probably not far of where a tablet like iPad becomes a healthcare provider’s primary portal into the their health IT system. Issues like battery life (I suspect 10 hours will be a stretch), infection control, multitasking, and ports for peripherals – these can all be improved in the coming iterations of the iPad. One thing worth remembering though – Apple’s Windows-based competitors will not be as far behind this time (see number 9). [...]
[...] connectivity may certainly help. However, critics list a plethora of reasons why the iPad has no place in the hospital. It’s inability to multitask or take a photo and lack of a USB port and Flash [...]
Based on more than 3 years of prototyping Tablet & Laptop PCs as mobile devices for physicians and clinicians – see http://www.healthcareitnews.com/news/m3-brings-... we know they work well in HC. Trouble is the IPad does not qualify as a Tablet PC. Here are some features that would need to be available for the IPad to be suitable. A Windows Boot, like the Mac, so that applications developed for a Windows environment can run unchanged; a Video Camera, even better 2, one facing the user and one on the other side, like the Sony laptop (the Intel sponsored Motion Computing device has one camera on the wrong side); an available Unified Communications solution like Cisco or Microsft offer, supporting video-conferencing & Presence Management; EVDO-LTE connectivity so that the superior Verizon Wireless data service can be used; replaceable battery so that auxiliary batteries can be carried so that 8+ hours of continuous use can be supported; and that's just for starters……..
Verizon steps up to the plate.
Well played Mr. Haigh. All solid points. Feel free to elaborate, as I'm sure your involvement/experience with the M3 device has much relevance in this discussion.
I see that your article was from 2007. What's the status of the M3 device as of 2010? Sounds promising, but I can't find any other info about it. Is it still in development or is it being offered commercially?
Please continue your prototyping as you have a ways to go.
1. “Tablet” qualification (whatever that is) is obviously not a plus, as the slew of PC tablets over the years has been a complete failure.
2. Windows, as stated above, is no longer a requirement. More and more vendors, even in the health field, are supporting non-proprietary, open standards. Just look at the number of EMR vendors with iPhone apps!
3. One or two video cameras is NOT necessary for health-related applications and may even pose a security or privacy concern.
4. EVDO is dead and LTE is not out yet. 3G or 4G is not required in a hospital or physician office. WiFi with WPA2 works perfectly well.
5. The 10 hour life of the iPad is perfect for hospital and physician use. At best this is a minor issue anyway.
Jared, I re-read your original article and found a few more errors:
2. “Unfortunately, the iPad doesn’t harness the power of OS X; it actually runs a modified version of the iPhone OS.” is incorrect as the iPhone actually runs a stripped down version of OS X with added 'Touch' interface features, as will the iPad.
5. Multi-tasking: The iPhone, contrary to what you and the other 'tech pundits' state, does multi-task. It runs the web browser, email, phone, iPod plus a bunch of background processes continually (eg: background notifications) all at the same time.
The Droid Fanboys love to tout the Android's so called multi-tasking but can't call some one and run a data-based program at the same time on Verizon's outdated CDMA network (something easily done on the iPhone).
See below
Peter J. Haigh, FHIMSS
412 720 6838
2. Noted and corrected.
5. I'll take “tech pundit” as a compliment.
I would like to make a distinction between being able to run multiple background processes and being able to run multiple applications. The iPod and phone services do allow you to perform other single functions simultaneously (web or email or apps). Without jail-breaking your iPhone then installing multifl0w, you absolutely cannot run multiple apps at the same time. Functions like sending an email from a web page contact link closes the web browser and opens the email application. Playing a YouTube video link from a webpage/other app drops Safari and starts the YouTube app. Downloaded apps from the App Store must be exited to enter another app.
The problem so far with tablets has been the lousy software. As a physician, I would like an app that I could dictate into, write on, and tap to access lab and imaging data. So far, that doesn't exist in any meaningful way. Also, templates are not useful to our way of thinking. The lack of camera, full OS and flash are all pluses in terms of maintaining privacy and keep people focused on the task. What advantage is there, after all, to running a simple information exchange program on a PC?
A Cloud Services Device in your hand — that's why the iPad looks so “big”, and why it deliberately shuns traditional features from personal computers. That's why people hate it. And why some love it.
Healthcare IT has struggled for a long time to bring the sort of services needed, to everywhere that they are needed. It is an area that might just be overtaken one day by companies that can build services for health on a larger and more integrated scale, and supporting an iPad will be trivial. But that will take maybe a decade. But it will leapfrog traditional healthcare IT systems that were built for a personal desktop metaphor.
The future is a myriad of connected screens with simple interfaces everywhere, synced to massive data centres. The iTunes store showed people were willing to use a music service. The iPhone app store showed people were willing to hand over “admin” tasks to a service that made getting software and installing it a task anyone can do walking down the street with three taps of their thumb.
Presumably a giant integrated service is what healthcare has wanted all along? Well the PC doesn't fit that. But it will take time. Much of existing software will need to be rewritten. But the hardware continues to become lighter and cheaper, and more ubiquitous, and networks provide ways to connect everything. So what matters most now is the actual data, and that always needed centralising anyway. So you're always wanted a service. PCs and small servers in departmental back rooms were just never architected for that sort of distributed scale.
All that data needs to be managed by professionals. Then it just needs to get where it is needed in the most convenient manner possible. A PC filesystem is pretty much irrelevant to that now, as a user exposed system. Multitouch and efficient CPUs and better battery technology and wider wireless networking is making the convenience factor ever more important. We won't necessarily be using Apple hardware in ten years, but the writing is on the wall for “personal” computing. Massive medical cloud services conveniently accessible by all who need them. That's the future.
Now that I have an iPad 'in my hand' I can report good success in the medical office and hospital environment. I can access our office EMR system just fine, along with our PACs system and the local hospital EMR works fine too (McKesson). The Citrix Receiver is on the App Store (free) too, although I have not used it (but it should work well for Remote Desktop Services (Terminal Services) with Windows and Windows-based EMR systems.
All in all, a wonderful addition to my doctor's bag!
1) I would have thought a tablet would be better than a keyboard in terms of keeping clean.
Opera zings and looks like it'll be available in a few days.
2) Yes, many healthcare organisations still use Windows… but how long can they keep using 3.1?
3) I agree I still don't warm to iTunes interface/limitations… but on the positive side I've never heard of anyone picking up a virus there.
4) It'll come down in price but most of us know that cheap computers offer very bad value.
5) OS4, ie it won't be an issue in a couple of weeks.
6) wireless offers less places for infection to fester.
7) just tell your IT people you're not going to carry around an ethernet cable any more!
9) I have a soft spot for Lenovo quality; even though the reputation was built on IBM quality; I'm still not sure Lenovo are completely safe hands.
10) Flash – You're not supposed to be playing games on the thing!
11) The prediction. You'll be using it and loving it within a year
Great post. More astute than the author of this much commented upon article.
PS: Opera is available for iPhone/iPad now –
http://itunes.apple.com/app/opera-mini-web-brow...
(Be aware that Opera Mini directs all traffic thru it's servers so one wonders whether there could be security issues.)
Man, Robert…you never let up, do you? I am a real person, so again, please keep it civil.
And good add BTW on the new Opera Mini app – very exciting.
1. You're right about cleaning. A pad should be easier. I was mainly thinking about the increased portability and the likelihood of going from one patient room/nurse station to another. The risk for spreading bugs increases dramatically, unless the clinician never actually sets the device down.
2. Some facilities are still on Windows XP (circa 2001). Changing operating systems is a huge endeavor for a facility of any size. Many are still waiting to see if Win7 will have the same fallout as Vista did.
5. OS4 brings application state snapshots that very much resemble Multitasking = AWESOME.
7. And they would laugh and send me on my merry way
8. Good point about Opera. I've only used Opera on mobile platforms. I'll give it a spin on the desktop this week.
11. Oh, if someone would only let me test an iPad for a while!
Sorry. You're right and I apologize.
[...] It’s not all wine and roses, though — skeptic Jared Houck at HIT Squad listed 10 reasons the iPad won’t succeed in health IT. [...]
[...] It’s not all wine and roses, though — skeptic Jared Houck at HIT Squad listed 10 reasons the iPad won’t succeed in health IT. [...]
I just installed the Opera browser on my iPhone and on hardwired (to hospital intranet) desktop. Opera doesn't seem to work on non-W3C compliant applications. Is Opera (desktop) also directing its traffic through their servers to do the heavy lifting? If so, Opera Mini on iPhone/iPad doesn't help at all – AND to your point, has the potential for major security implications. Have you had any luck?
Opera Mini does pass requests through their servers, which can be a problem if the hospital is blocking outside IP addresses and also brings up potential security concerns.
In my limited testing, I like Safari more as it renders pages better and I didn't see much of a speed advantage.
PCMag did a nice review:
http://www.pcmag.com/article2/0,2817,2362599,00...
BTW iPad?!! What's wrong with Apple's grammer ! Why is it not Ipad, I-Pad or Ipad. Maybe this is a subtle way of saying that I (the person who bought the iPad) am of no (or low) importance (note the 'i' ) as compared to the Pad (capital 'P' – belonging to Apple)!
Apple has little to worry about if that is the best you can come up with.
On #8 and Opera, you seem to have a weak grasp. The directive is to keep individuals not authorized to do so from sseeing your medical records, but nothing is iron-clad. Matter of fact, today, your file could be left on a counter at the Nurse's station, and someone could take a peak. The chances of someone hacking the Opera data center in Norway and seeing an individual's records are much more remote.
I found your post interesting. I couldn't agree with you more. I posted a few additional points you can check out at: http://www.macadamian.com/insight/healthcare_de...
Interesting article re: Flash points out why the iPad is the perfect device for health care professionals from a security standpoint:
“If you look at the list of what the iPad is missing, you'll discover a security wonk's greatest dreams:
-Difficult or impossible for unauthorized background processes to run.
-One-to-one user-to-system mapping obviates the need for RBAC.
-Limited software availability with baroque approvals process.
-Limited (8 pages at a time) browser with mature engine and standards support.
-Limited local storage with only api access to locally stored information.
-Limited server processes listening (just the iTunes mDNS listener).
-No Adobe Reader (uses an Apple authored PDF interpreter).
-No Adobe Flash.
http://www.csoonline.com/article/592038/Will_iP...
Jared:
You present excellent points as to the future of the iPad and its role in Electronic Medical Records. We see many docs betting that this EMR/iPad app as a alternative to Saas or Client-server configs.
Recent Comments
Topics
Categories
Recent Posts